Basic Information
| Provider Information | |||||||||
| NPI: | 1417373986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EBBERT | ||||||||
| FirstName: | JANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 314 S WELLS ST | ||||||||
| Address2: | |||||||||
| City: | SISTERSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261751098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046522611 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 999 CHERAW ST | ||||||||
| Address2: | |||||||||
| City: | BENNETTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295122420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434792341 | ||||||||
| FaxNumber: | 8434792346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2014 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25215 | MS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 3393 | WV | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 81620 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.